Basic Information
| Provider Information | |||||||||
| NPI: | 1033559935 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FRANK | ||||||||
| FirstName: | TIFFANY | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | M.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2314 29TH ST APT 3 | ||||||||
| Address2: | |||||||||
| City: | ASTORIA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 111052897 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5162970021 | ||||||||
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| Practice Location | |||||||||
| Address1: | 24302 NORTHERN BLVD | ||||||||
| Address2: | |||||||||
| City: | DOUGLASTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113621150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184236200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2013 | ||||||||
| LastUpdateDate: | 08/08/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | P90273 | NY | N | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TC0700X | 020746 | NY | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.